In 1980, armed with an aptitude for science, Dawn Endris was 19 years old, “fresh out of high school” and had her career path already chosen.
“I always wanted to get into nursing,” she recalls, but dropped out of nursing school after her freshman year when her first child was born.
Two decades later, after a name change to Dawn Pullen attendant to her second marriage, she acquired a Brady Bunch of nine children—hers, his and theirs. Then, in the fall of 2000, with her ninth, a newborn son, carried to class in her arms, she embarked again on her dream quest, beginning an accelerated, bachelor's of nursing degree program at Valparaiso University in Indiana.
“I felt, I'd better do what I wanted to do,” Pullen says. “It's never too late, correct?”
Even though she didn't know it at the time, that decision started her on the long road to a career in nursing informatics.
Pullen graduated in 2003, then went on to get her MBA and a master's degree in nursing. Pullen, meanwhile, became involved with computers at the University of Chicago Medical Center, where in 2007 she found “a lot of open doors,” helping in its big push toward an EHR, first serving as a “clinical nurse educator” in nursing informatics. From there, she says, “I got into the middle of projects, and that just kept on growing and growing.”
Pullen's path to nursing informatics was more roundabout than most, but in a field as old as healthcare informatics—it dates to the 1960s when computers were first being put to use in academic research—many of the leaders and practitioners of nursing informatics contacted for this story say they came to their own careers in much the same way as Pullen—by informal learning at first, often with the goal of helping to teach others—and then, one thing just led to another.
She still calls Northwest Indiana home, but today she is a road warrior, a nursing informatics specialist on extended assignments with CSI Healthcare IT, a Jacksonville, Fla.-based consulting firm, most recently installing EHR systems at several Florida hospitals.
Pullen and many of other nurse informaticists have worked in a variety of disciplines within the broader field, or know of peers who have, including academic and pharmaceutical research; epidemiology and public health; home health; long-term, inpatient and outpatient care; quality improvement and patient safety; as well as project management and systems design. Others have used their experiences as a foundation for national health IT leadership.
Veteran nurse informaticist Judy Murphy is one of 33 “nursing informatics pioneers” to be videotaped as part of the Nursing Informatics History Project co-sponsored by the American Medical Informatics Association and the National Library of Medicine. She began her career in nursing informatics in the late 1970s, teaching fellow nurses how to use some of the early healthcare clinical applications, then running on mainframe computers.
Murphy is among the highest-profile members of the profession today, serving since late 2011 as deputy national coordinator for programs and policy at the Office of the National Coordinator for Health Information Technology at HHS. In her interview for the history project, she defined nursing informatics not just as the intersection of the sciences of nursing, computers and information, but also as the confluence of people, process and technology.
Nurses, who bring a “holistic” approach to healthcare, add the same to the national healthcare IT strategy as nursing informaticists, Murphy says.
“Nurses have always approached their work with the problem-solving approach we call the nursing process,” she says. “We're pretty methodical about doing that. You're always assessing and drawing conclusions, so we're natural project managers. We know how to coordinate.”
Mary Beth Mitchell, chief nursing informatics officer at 13-hospital Texas Health Resources based in Arlington, also took an indirect path. “We all kind of fell into it,” she says. “I was a clinical nurse (in 1998) and was asked to be the expert on a documentation system implementation. And then they said, 'Why don't you become the nursing informatics manager?' And I said, 'Oh, great. What's nursing informatics?' ”
Mitchell, of course, is a bit facetious. “It's been around since the 1960s,” she says, “but it really didn't gain a lot of traction until we got these clinical systems in, and that was in the 1990s, mostly in academia.”
Vicki Vallejos, manager of clinical informatics at Clark Memorial Hospital in Jeffersonville, Ind., is president of the 3,000-member American Nursing Informatics Association. She began her career in the early 1990s, typing up physician orders on a word processor.
“Just because I was the nurse who had her hands on a keyboard, I was named project manager for computer implementation in home health,” Vallejos says. Her job was to train staffers on how to use a laptop and download reports. “I figured out I was doing informatics in 1994, when a position opened up in the hospital for a clinical analyst. It was the first time we ever had one.”
Today, she works with seven nurses officially titled as informaticists and four more nurses without the titles who, nonetheless, are “go-to people out on the floor.”
“What I learned, I learned by the seat of my pants,” says Bonnie Westra, associate professor and co-director of the Center for Nursing Informatics at the University of Minnesota School of Nursing. In the 1990s, Westra and a partner, a software engineer, launched CareFacts Information Systems, initially a developer of EHRs for home care, hospitals and public health agencies. It was sold two years ago.
“I remember trying to understand databases and (her partner) handing me a book and said, 'Here, go learn,' ” she says.
Today, the university offers seven programs in informatics geared toward healthcare professionals, including nurses. “We give them a database class,” she says. “We teach them (database) design and what's the role of the nurse versus the programmer. I really didn't know a lot about project management. That was a terrible lesson to learn. I'm a lot smarter now on how to link evidence-based practice with clinical decision support.”
Growth in the profession is robust, based on multiple metrics, including an explosion in educational opportunities.
There are now 42 accredited master's degree programs and six doctoral programs with majors in nursing informatics, says Robert Rosseter, spokesman for the American Association of Colleges of Nursing. Enrollment in these post-graduate programs, now at 2,741 students, is up 19% over a year ago.
Meanwhile, the American Nurses Credentialing Center, a subsidiary of the American Nurses Association, which conducted its first exam and issued its first credential in nursing informatics in 1996, has 1,234 certified nurse informaticists credentialed, including 231, or 19%, who were certified just last year.
“I would suggest to you the demand is going to increase tremendously,” says Karen Drenkard, the center's executive director. “You can't function without informatics in the healthcare environment.” The numbers of nurses receiving advanced degrees and applying for credentials reflects the supply of nurses “trying to meet the demand,” she says.
Compensation for these professionals is soaring, too. In a 2011 survey of 660 nurse informaticists conducted by the Healthcare Information and Management Systems Society, the average salary for a nurse informaticist was $98,702, compared with $83,675 in a similar survey in 2007 and $69,500 in 2004. The median salary in 2011 was $88,000.
And the settings where nurse informaticists are working are as diverse as the nursing profession itself.
Nearly half of respondents to the latest HIMSS survey (48%) worked in hospitals, but another 20% were employed in corporate offices of health systems, 18% worked for physician offices, home health agencies, insurers and other organizations, 9% were academics and 5% worked for consulting firms or IT vendors.
Job titles were a mixed bag, with just one in five holding the most common title, “nursing informatics specialist.” But whatever the position is called, it's almost always a full-time IT job. Fully 77% surveyed indicated they “rarely” spent time on clinical activities, with another 19% saying they spent less than one-fourth of their time on clinical duties.
Mitchell, of Texas Health Resources, says that for her, a little moxie and a few years of clinical and computer experience are a winning combination for nurses looking for a career in informatics.
She says she sees “a big surge” of nurses going into nursing informatics training programs, and then looking for jobs without a lot of in-the-trenches informatics experience.
“I think they have a bit harder time,” Mitchell says. “I encourage nurses to work as super-users and learn everywhere you can, and then rounding it out with formal education. I look for innate ability, an understanding of the technology and the nursing piece, and how motivated you've been. If you've worked through an implementation and never volunteered to be a super-user or involved in the implementation, I ask, why didn't you volunteer when you had the chance?”
Pullen, the late bloomer, says she gets asked a lot whether she regrets leaving the clinical setting. She says, in her mind, she hasn't.
“I'm still exposed to that, but I think on my end of it, we can set up a decision-support system that's all about patient safety,” she says. “It's all about communication among the whole, interdisciplinary team. Ultimately, it's going to improve all of those clinical decision processes.”